Mr Chan (M/34) came for eye examination, vision with existing glasses is fine seeing far & near. He sometimes has tired, blurry near vision upon prolonged near work.
Vision without glasses
R: 6/60-
L: 6/30-
Vision with existing glasses of 7-8years (lenses have been refitted into a new frame due to broken frame)
R: -6.75/-0.75×20 (6/7.5+2)
L: -4.50/-1.25×5 (6/6)
Examination shows: (Delay Fogging)
R: -6.00/-1.00×180 (6/6) [+1.00 blur lens test: 6/7.5-] (R: right dominant eye) R>L
L: -4.25/-1.25×10 (6/6) [+1.00 blur lens test: 6/9-]
Add: +0.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 EP (yellow part)
Near: 2 – 4 XP (blue part)
+1.00 Near: 4 XP (blue part)
-1.00 Near: 0 – 1 EP (yellow part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.25/PL
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 34 YO, 34 YO, 34 YO
L: 38 YO, 38 YO, 38 YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-1.00)
BE: 14 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 10 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with left eye]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 20/x/x
Near, Base-In/Divergent, NFV: x/20/14
Distance, Base-In/Divergent, NFV: 12/14/12
Distance, Base-Out/Convergent, PFV: 20/x/x
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 5 cpm (double with Base In)
Distance: 14 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 7.0cm
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Colour Vision
R: R-G
L: R-G
(normal value: normal)
Slit Lamp Assessment
Fluorescein
R: -ve staining
L: -ve staining